Systematic review of outcome domains and instruments used in clinical trials of tinnitus treatments in adults

BACKGROUND: There is no evidence-based guidance to facilitate design decisions for confirmatory trials or systematic reviews investigating treatment efficacy for adults with tinnitus. This systematic review therefore seeks to ascertain the current status of trial designs by identifying and evaluating the reporting of outcome domains and instruments in the treatment of adults with tinnitus. METHODS: Records were identified by searching PubMed, EMBASE CINAHL, EBSCO, and CENTRAL clinical trial registries (ClinicalTrials.gov, ISRCTN, ICTRP) and the Cochrane Database of Systematic Reviews. Eligible records were those published from 1 July 2006 to 12 March 2015. Included studies were those reporting adults aged 18 years or older who reported tinnitus as a primary complaint, and who were enrolled into a randomised controlled trial, a before and after study, a non-randomised controlled trial, a case-controlled study or a cohort study, and written in English. Studies with fewer than 20 participants were excluded. RESULTS: Two hundred and twenty-eight studies were included. Thirty-five different primary outcome domains were identified spanning seven categories (tinnitus percept, impact of tinnitus, co-occurring complaints, quality of life, body structures and function, treatment-related outcomes and unclear or not specified). Over half the studies (55 %) did not clearly define the complaint of interest. Tinnitus loudness was the domain most often reported (14 %), followed by tinnitus distress (7 %). Seventy-eight different primary outcome instruments were identified. Instruments assessing multiple attributes of the impact of tinnitus were most common (34 %). Overall, 24 different patient-reported tools were used, predominantly the Tinnitus Handicap Inventory (15 %). Loudness was measured in diverse ways including a numerical rating scale (8 %), loudness matching (4 %), minimum masking level (1 %) and loudness discomfort level (1 %). Ten percent of studies did not clearly report the instrument used. CONCLUSIONS: Our findings indicate poor appreciation of the basic principles of good trial design, particularly the importance of specifying what aspect of therapeutic benefit is the main outcome. No single outcome was reported in all studies and there was a broad diversity of outcome instruments. PROSPERO REGISTRATION: The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): CRD42015017525 . Registered on 12 March 2015 revised on 15 March 2016.

Effect of pre-treatments and post-treatments on drying products

Freeze drying technology can give good quality attributes of vegetables and fruits in terms of color, nutrition, volume, rehydration kinetics, stability during storage, among others, when compared with solely air dried ones. However, published scientific works showed that treatments applied before and after air dehydration are effective in food attributes, improving its quality. Therefore, the hypothesis of the present thesis was focus in a vast research of scientific work that showed the possibility to apply a pre-treatment and a post-treatment to food products combined with conventional air drying aiming being close, or even better, to the quality that a freeze dried product can give. Such attributes are the enzymatic inactivation, stability during storage, drying and rehydration kinetics, color, nutrition, volume and texture/structure. With regard to pre-treatments, the ones studied along the present work were: water blanching, steam blanching, ultrasound, freezing, high pressure and osmotic dehydration. High electric pulsed field was also studied but the food attributes were not explained on detailed. Basically, water and steam blanching showed to be adequate to inactivate enzymes in order to prevent enzymatic browning and preserve the product quality during long storage periods. With regard to ultrasound pre-treatment the published results pointed that ultrasound is an effective pre-treatment to reduce further drying times, improve rehydration kinetics and color retention. On the other hand, studies showed that ultrasound allow sugars losses and, in some cases, can lead to cell disruption. For freezing pre-treatment an overall conclusion was difficult to draw for some food attributes, since, each fruit or vegetable is unique and freezing comprises a lot of variables. However, for the studied cases, freezing showed to be a pre-treatment able to enhance rehydration kinetics and color attributes. High pressure pre-treatment showed to inactivate enzymes improving storage stability of food and showed to have a positive performance in terms of rehydration. For other attributes, when high pressure technology was applied, the literature showed divergent results according with the crops used. Finally, osmotic dehydration has been widely used in food processing to incorporate a desired salt or sugar present in aqueous solution into the cellular structure of food matrix (improvement of nutrition attribute). Moreover, osmotic dehydration lead to shorter drying times and the impregnation of solutes during osmose allow cellular strengthens of food. In case of post-treatments, puffing and a new technology denominated as instant controlled pressure drop (DIC) were reported in the literature as treatments able to improve diverse Abstract Effect of Pre-treatments and Post-treatments on Drying Products x food attributes. Basically, both technologies are similar where the product is submitted to a high pressure step and the process can make use of different heating mediums such as CO2, steam, air and N2. However, there exist a significant difference related with the final stage of both which can comprise the quality of the final product. On the other hand, puffing and DIC are used to expand cellular tissues improving the volume of food samples, helping in rehydration kinetics as posterior procedure, among others. The effectiveness of such pre and/or post-treatments is dependent on the state of the vegetables and fruits used which are also dependent of its cellular structure, variety, origin, state (fresh, ripe, raw), harvesting conditions, etc. In conclusion, as it was seen in the open literature, the application of pre-treatments and post-treatments coupled with a conventional air dehydration aim to give dehydrated food products with similar quality of freeze dried ones. Along the present Master thesis the experimental data was removed due to confidential reasons of the company Unilever R&D Vlaardingen